LEUKEMIA PPT BY MWEBAZA VICTOR 2023 mwebazavictor1997@gmail.com

1. mwebazavictor1997@gmail.com
MBChB 6th YEAR
UGANDA
Kampala international university western
campus Jinja site light
JINJA REGIONAL REFERRIAL HOSPITAL
Internal Medicine Department
LEUKEMIA PRESENTATION
Moderator : DR. KIBUUKA AFIZI
(consultant JRRH)
2nd /3/2023 1hour session
MWEBAZA VICTOR

2. Ethical dilemmas in the care of cancer
patients near the end of life
In the cancer patient near the
end of life, common ethical
dilemmas include;
those dealing with artificial
nutrition and hydration,
truth-telling and
disagreements over
management plans.
It would stand the clinician in
good stead to be aware of
these issues and have an
approach toward dealing
with such problems
What are the 4 dilemmas?
1. Good for the unit versus
good for the whole.
2. Good for the short term
versus good for the long
term.
3. Truth versus loyalty.
4. Justice versus mercy.

3. History of leukemia
1. Leukemia was first described by anatomist and
surgeon Alfred-Armand-Louis-Marie Velpeau in
1827.
2. A more complete description was given by
pathologist Rudolf Virchow in 1845.
3. Neumann to conclude that a bone marrow
problem was responsible for the abnormal blood
of people with leukemia.

4. "Targeting leukemia: From bench to bedside". FASEB Journal. 16
(3): 273. doi:10.1096/fj.02-0029bkt. PMID 11874976.

5. By 1900 leukemia was viewed as a family of
diseases as opposed to a single disease.
By 1947 Boston pathologist Sidney Farber
believed from past experiments that
aminopterin, a folic acid mimic, could
potentially cure leukemia in children.
In 1962, researchers Emil J. Freireich, Jr. and
Emil Frei III used combination
chemotherapy to attempt to cure
leukemia
Patlak, M (2002). "Targeting leukemia: From bench to bedside". FASEB Journal. 16 (3): 273. doi:10.1096/fj.02-0029bkt.
PMID 11874976.

6. Review on
haematopoiesis byapicture

8. Whatis leukemia
Leukemia, also spelled leukaemia, is a group of blood
cancers that usually begin in the bone marrow and
result in high numbers of abnormal blood cells.
These blood cells are not fully developed and are
called blasts or leukemia cells.
What You Need To Know About™ Leukemia". National Cancer Institute. 23 December 2013. Archived from the original on 6
July 2014. Retrieved 18 June 2014.

9. EPIDEMIOLOGY by 2019 to 2021

10. Incidence of leukaemia in selected counties 2021

11. U.C.I 2020 Report on cancer
awareness

13. On the 4th of September 2023, World Leukemia Day, we're asking you
to help us raise more awareness of leukemia. Our topic this
year: what leukemia means to you.

14. C la ssificatio n o f leukemia
SPEC IFIC TYPES
CELL TYPE ACUTE CHRONIC
Lymphocytic leukemia
(or "lymphoblastic")
Acute lymphoblastic
leukemia
(ALL)
Chronic lymphocytic
leukemia
(CLL)
Myelogenous leukemia
("myeloid" or
"nonlymphocytic")
Acute myelogenous
leukemia
(AML or myeloblastic)
Chronic myelogenous
leukemia
(CML)

15. Specific types
1. Acute lymphoblastic leukemia (ALL) is the most
common type of leukemia in young children. It
also affects adults, especially those 65 and older.
Standard treatments involve chemotherapy and
radiotherapy.
Subtypes include precursor B acute lymphoblastic
leukemia, precursor T acute lymphoblastic
leukemia, Burkitt's leukemia, and acute
biphenotypic leukemia.
While most cases of ALL occur in children, 80% of
deaths from ALL occur in adults.

16. 2 . Chronic lymphocytic leukemia (CLL) most
often affects adults over the age of 55.
It sometimes occurs in younger adults, but it
almost never affects children.
Two-thirds of affected people are men. The five-
year survival rate is 85%.
It is incurable, but there are many effective
treatments.
One subtype is B-cell prolymphocytic leukemia, a
more aggressive disease.

17. 3 . Acute myelogenous leukemia (AML) occurs
far more commonly in adults than in children,
and more commonly in men than women.
It is treated with chemotherapy. The five-year
survival rate is 20%.
Subtypes of AML include acute promyelocytic
leukemia, acute myeloblastic leukemia, and
acute megakaryoblastic leukemia.

18. 4 . Chronic myelogenous leukemia (CML) occurs
mainly in adults; a very small number of
children also develop this disease.
It is treated with imatinib (Gleevec in United
States, Glivec in Europe) or other drugs. The
five-year survival rate is 90%.
One subtype is chronic myelomonocytic
leukemia.

23. 5 . Hairy cell leukemia (HCL) is sometimes
considered a subset of chronic lymphocytic
leukemia, but does not fit neatly into this
category.
About 80% of affected people are adult men. No
cases in children have been reported.
HCL is incurable but easily treatable. Survival is
96% to 100% at ten years.

24. 6 . T-cell prolymphocytic leukemia (T-PLL) is a
very rare and aggressive leukemia affecting
adults; somewhat more men than women are
diagnosed with this disease.
Despite its overall rarity, it is the most common
type of mature T cell leukemia; nearly all other
leukemias involve B cells.
It is difficult to treat, and the median survival is
measured in months

25. 7 . Large granular lymphocytic leukemia may
involve either T-cells or NK cells; like hairy cell
leukemia, which involves solely B cells, it is a
rare and indolent (not aggressive) leukemia.

26. 8 . Adult T-cell leukemia is caused by human T-
lymphotropic virus (HTLV), a virus similar to
HIV. Like HIV, HTLV infects CD4+ T-cells and
replicates within them; however, unlike HIV, it
does not destroy them.
Instead, HTLV "immortalizes" the infected T-cells,
giving them the ability to proliferate
abnormally. Human T-cell lymphotropic virus
types I and II (HTLV-I/II) are endemic in certain
areas of the world.

27. 9 . Clonal eosinophilias (also called clonal
hypereosinophilias) are a group of blood disorders
characterized by the growth of eosinophils in the
bone marrow, blood, and/or other tissues.
They may be pre-cancerous or cancerous. Clonal
eosinophilias involve a "clone" of eosinophils, i.e., a
group of genetically identical eosinophils that all
grew from the same mutated ancestor cell.
These disorders may evolve into chronic eosinophilic
leukemia or may be associated with various forms of
myeloid neoplasms, lymphoid neoplasms,
myelofibrosis, or the myelodysplastic syndrome.

28. Pre - leukemia / transient leukemia
Transient myeloproliferative disease, Involves the
abnormal proliferation of a clone of non-cancerous
megakaryoblasts.
The disease is restricted to individuals with Down
syndrome or genetic changes similar to those in
Down syndrome, develops in a baby during
pregnancy or shortly after birth, and resolves
within 3 months or, in ~10% of cases, progresses
to acute megakaryoblastic leukemia.
Transient myeloid leukemia is a pre-leukemic
condition.
Crispino JD, Horwitz MS (April 2017). "GATA factor mutations in hematologic disease". Blood. 129 (15): 2103–2110. doi:10.1182/blood-2016-09-
687889. PMC 5391620. PMID 28179280.

29. Signs and symptoms
The most common symptoms in children are easy
bruising, pale skin, fever, and an enlarged spleen or
liver , lymphadenopathy .
Damage to the bone marrow, by way of displacing the
normal bone marrow cells with higher numbers of
immature white blood cells, results in a lack of blood
platelets, which are important in the blood clotting
process. This means people with leukemia may easily
become bruised, bleed excessively, or develop pinprick
bleeds (petechiae).
Clarke, RT; Van den Bruel, A; Bankhead, C; Mitchell, CD; Phillips, B; Thompson, MJ (October 2016). "Clinical presentation of childhood leukaemia:
a systematic review and meta-analysis". Archives of Disease in Childhood. 101 (10): 894–901. doi:10.1136/archdischild-2016-311251.
PMID 27647842.

30. White blood cells, may be suppressed or
dysfunctional. This could cause the person's
immune system to be unable to fight off infection,
ranging from infected tonsils, sores in the mouth,
or diarrhea to life-threatening pneumonia or
opportunistic infections.
Finally, the red blood cell deficiency leads to anemia,
which may cause dyspnea and pallor.
Some people experience other symptoms, such as
feeling sick, having fevers, chills, night sweats,
feeling fatigued and other flu-like symptoms.
unintentional weight loss.
"Leukemia". Columbia Electronic Encyclopedia, 6th Edition. Retrieved 4 November 2011.

32. Causes
Leukemia, like other cancers, results from mutations
in the DNA. Certain mutations can trigger leukemia
by activating oncogenes or deactivating tumor
suppressor genes, and thereby disrupting the
regulation of cell death, differentiation or division.
These mutations may occur spontaneously or as a
result of exposure to radiation or carcinogenic
substances.
Radivoyevitch, T; Sachs, R K; Gale, R P; Molenaar, R J; Brenner, D J; Hill, B T; Kalaycio, M E; Carraway, H E; Mukherjee, S (2015). "Defining AML and MDS
second cancer risk dynamics after diagnoses of first cancers treated or not with radiation". Leukemia. 30 (2): 285–294. doi:10.1038/leu.2015.258.
PMID 26460209. Archived from the original on 29 August 2021. Retrieved 3 August 2020.

33. Among adults, the known causes are natural and
artificial ionizing radiation, a few viruses such as
human T-lymphotropic virus, and some chemicals,
notably benzene and alkylating chemotherapy
agents for previous malignancies.
Use of tobacco is are risk of developing acute
myeloid leukemia in adults. Cohort and case-
control studies have linked exposure to some
petrochemicals and hair dyes to the development
of some forms of leukemia.
Ross JA, Kasum CM, Davies SM, Jacobs DR, Folsom AR, Potter JD (August 2002). "Diet and risk of leukemia in the Iowa Women's Health Study".
Cancer Epidemiol. Biomarkers Prev. 11 (8): 777–81. PMID 12163333. Archived from the original on 10 September 2017.

34. Historical REPORT published in 2013
A few cases of maternal-fetal transmission have
been reported. Children born to mothers who
use fertility drugs to induce ovulation are
more than twice as likely to develop leukemia
during their childhoods than other children.
Rudant J, Amigou A, Orsi L, Althaus T, Leverger G, Baruchel A, Bertrand Y, Nelken B, Plat G, Michel G, Sirvent N, Chastagner P, Ducassou S, Rialland
X, Hémon D, Clavel J (2013). "Fertility treatments, congenital malformations, fetal loss, and childhood acute leukemia: the ESCALE study (SFCE)".
Pediatr Blood Cancer. 60 (2): 301–8. doi:10.1002/pbc.24192. PMID 22610722.

35. Diagnosis
1. Diagnosis is usually based on repeated complete
blood counts and a bone marrow examination
following observations of the symptoms.
2. A lymph node biopsy can be performed to
diagnose certain types of leukemia in certain
situations.
3. Following diagnosis, blood chemistry tests RFT,
LFT.
4. X-ray, MRI, or ultrasound ,CT scans
American Cancer Society (2010). "How is Leukemia Diagnosed?". Detailed Guide: Leukemia – Adult Chronic. American Cancer Society. Archived
from the original on 5 April 2010. Retrieved 4 May 2010.

36. MANAGEMENT OF LEUKEMIAS
Most forms of leukemia are treated with
pharmaceutical medication, typically
combined into a multi-drug chemotherapy
regimen. Some are also treated with radiation
therapy. In some cases, a bone marrow
transplant is effective.

37. Acute lymphoblastic mgt
1. Induction chemotherapy For adults, include prednisone, vincristine, and an
anthracycline drug; other drug plans may include L-asparaginase or
cyclophosphamide. For children with low-risk ALL, (prednisone, L-asparaginase,
and vincristine) for the first month of treatment.
2. Consolidation therapy , multi-drug treatment that is undertaken for a few
months. People with low- to average-risk ALL receive therapy with antimetabolite
drugs such as methotrexate and 6-mercaptopurine (6-MP). People who are high-
risk receive higher drug doses of these drugs, plus additional drugs.
3. Maintenance treatments usually involves lower drug doses, and may continue
for up to three years.
4. Alternatively, allogeneic bone marrow transplantation may be appropriate for
high-risk or relapsed people.
Hoffbrand, A.V.; Moss, P.A.H.; Pettit, J.E. Essential haematology (5th ed.). Malden, Mass.: Blackwell Pub. ISBN 978-1-4051-3649-5.

38. Chronic lymphocytic mgt
Most CLL cases are incurable by present
treatments, so treatment is directed towards
suppressing the disease for many years, rather
than curing it.
The primary chemotherapeutic plan is
combination chemotherapy with chlorambucil
or cyclophosphamide, plus a corticosteroid
such as prednisone or prednisolone.

39. ROLE OF CORTICOSTEROIDS AND ALT
mgt OF THE Chronic lymphocytic.
The use of a corticosteroid has the additional
benefit of suppressing some related autoimmune
diseases, such as immunohemolytic anemia or
immune-mediated thrombocytopenia.
In resistant cases, single-agent treatments with
nucleoside drugs such as fludarabine,
pentostatin, or cladribine may be successful.
Younger and healthier people may choose
allogeneic or autologous bone marrow
transplantation in the hope of a permanent cure.
Gribben JG "Stem cell transplantation in chronic lymphocytic leukemia". Biol. Blood Marrow Transplant. 15 (1 Suppl): 53–8.
doi:10.1016/j.bbmt.2008.10.022. PMC 2668540. PMID 19147079.

40. Acute myelogenous mgt
Many different anti-cancer drugs are effective
for the treatment of AML.
In general, most oncologists rely on
combinations of drugs for the initial, induction
phase of chemotherapy. Such combination
chemotherapy usually offers the benefits of
early remission and a lower risk of disease
resistance.
American Cancer Society (22 March 2012). "Typical treatment of acute myeloid leukemia (except promyelocytic M3)". Detailed Guide: Leukemia
– Acute Myeloid (AML). American Cancer Society. Archived from the original on 12 November 2012. Retrieved 31 October 2012.

41. Chronic myelogenous mgt
There are many possible treatments for CML, but
the standard of care for newly diagnosed people
is imatinib (Gleevec) therapy. With this drug,
more than 90% of people will be able to keep the
disease in check for at least five years, so that
CML becomes a chronic, manageable condition.
In a more advanced, uncontrolled state, when the
person cannot tolerate imatinib, or if the person
wishes to attempt a permanent cure, then an
allogeneic bone marrow transplantation may be
performed
Fausel C (October 2007). "Targeted chronic myeloid leukemia therapy: seeking a cure" (PDF). J Manag Care Pharm. 13 (8 Suppl A): 8–12.
PMID 17970609. Archived from the original (PDF) on 28 May 2008. Retrieved 18 May 2008.

42. Teeth
Before dental work it is recommended that the
person's physician be consulted. Dental work is
recommended before chemotherapy or
radiation therapy. Those in remission can be
treated per normal
Mancheno Franch, A.; Gavalda Esteve, C.; Sarrion Perez, MG. (2011). "Oral manifestations and dental management of patient with leukocyte
alterations". Journal of Clinical and Experimental Dentistry: e53–e59. doi:10.4317/jced.3.e53. ISSN 1989-5488.

43. THANK YOU
MWEBAZA VICTOR
Ugandan
MBChB 6TH YEAR
mwebazavictor1997@gmail.com
LEUKEMIA PRESENTATION @ JRRH / KIU WC
2ND /3/2023